US20030083543A1 - Hernia prosthesis - Google Patents

Abstract

A prosthesis and a method for repairing a tissue or muscle wall defect, such as an inguinal hernia, near a cord-like structure, such as the spermatic cord. The prosthesis comprises a layer of repair fabric having a cord opening therethrough that is adapted to receive the cord-like structure when the prosthesis is implanted at the repair site. The prosthesis also includes a cord protector that is attachable to the repair fabric at the opening to isolate the cord-like structure from the fabric in proximity to the opening. The repair fabric may be formed from a material which is susceptible to the formation of adhesions with sensitive tissue and organs. The cord protector may be formed from material which inhibits the formation of adhesions with sensitive tissue and organs. The cord protector may overlie a portion of at least one of the first and second surfaces of the repair fabric. The cord protector may extend substantially farther away from the opening edge on one of the first and second surfaces than on the other of the first and second surfaces. The cord protector may be configured as an insert that is separate from and attachable to the repair fabric. Alternatively, the cord protector may be integral with the repair fabric to form a composite prosthesis.

Description

• This application is a continuation of U.S. patent application Ser. No. 09/627,855, filed on Jul. 28, 2000, entitled “Hernia Prosthesis,” now pending, and which claims the benefit of U.S. Provisional Patent Application Serial No. 60/146,061, filed on Jul. 28, 1999, entitled “Inguinal Hernia Patch.”[0001]
BACKGROUND OF THE INVENTION
• 1. Field of the Invention[0002]
• The present invention relates to a prosthesis for hernia repair. In particular, the present invention relates to a prosthesis for hernia repair configured to protect a cord passing through the prosthesis, such as the spermatic cord when the prosthesis is employed in an inguinal hernia repair.[0003]
• 2. Discussion of Related Art[0004]
• Various prosthetic materials have been proposed to reinforce the abdominal wall and to close abdominal wall defects. In certain procedures, the prosthetic fabric may come into contact with sensitive tissue or organs potentially leading to postoperative adhesions between the mesh and the sensitive tissue or organs. There has been a suggestion that, in an inguinal hernia repair, the prosthetic fabric may come into direct contact with the spermatic cord. Postoperative adhesions between the mesh and the spermatic cord and/or erosion of the mesh into the cord, were they to occur, could potentially affect spermatic cord structure and function. For example, tissue ingrowth could potentially result in infertility, pain or other detrimental effects due to strangulation of the spermatic cord.[0005]
• Uzzo et al., “The Effects of Mesh Bioprosthesis on the Spermatic Cord Structures: A Preliminary Report in a Canine Model”, The Journal of Urology, Vol. 161, April 1999, pp. 1344-1349, suggests that the interposition of autologous fat between the mesh and the cord during open inguinal repair may prove beneficial. It had been proposed in U.S. Pat. No. 5,593,441, assigned to C.R. Bard, Inc., also the assignee of the present application, to repair ventral hernias and/or reconstruct chest walls using a prosthesis that is covered with an adhesion resistant barrier, such as a sheet of expanded PTFE. In the repair of ventral hernias and in chest wall reconstruction, the composite is positioned with the barrier relative to the region of potential adhesion, such as the abdominal viscera. Other configurations of composite prostheses can be found in U.S. Pat. Nos. 5,725,577 and 5,743,917, both of which are also assigned to C.R Bard, Inc.[0006]
• International Publication No. WO 97/35533, by the present Applicant and also assigned to C.R. Bard, Inc., proposed a universal composite prosthesis in which one side of a layer of mesh material is completely covered with a layer of barrier material. The mesh material promotes biological tissue ingrowth while the barrier material retards biological tissue adherence thereto. The prosthesis may be utilized for various surgical procedures, including ventral hernia repair and inguinal hernia repair.[0007]
• It is an object of the present invention to provide an improved method and prosthesis for the repair of hernias.[0008]
SUMMARY OF THE INVENTION
• The present invention is a prosthesis and a method for mending a tissue or muscle wall defect, and has particular application in inguinal canal repairs near the spermatic cord. The prosthesis comprises a layer of repair fabric having a cord opening therethrough that is adapted to receive a cord-like structure, such as the spermatic cord, when the prosthesis is implanted at the repair site. The prosthesis also includes a cord protector that is attachable to the repair fabric at the cord opening to isolate the cord-like structure from at least the fabric in proximity to the cord opening. The repair fabric may be formed from a material which is susceptible to the formation of adhesions with sensitive tissue and organs. The cord protector may be formed from material which inhibits the formation of adhesions with sensitive tissue and organs.[0009]
• In one embodiment of the invention, the repair fabric includes first and second surfaces and an opening having an edge that is defined by a portion of the layer of repair fabric. The cord protector covers a substantial portion of the edge to isolate the substantial portion of the edge from the cord-like structure.[0010]
• In another embodiment of the invention, a layer of mesh fabric has a keyhole opening therethrough, and the cord protector extends about the keyhole opening and overlaps a portion of the layer of mesh fabric on opposing first and second surfaces thereof at least proximate the keyhole opening. The cord protector is adapted to receive the cord-like structure therethrough so that the layer of fabric is isolated from the cord-like structure by the cord protector at least proximate the keyhole opening.[0011]
• The cord protecting material may extend away from the opening edge on the first surface and/or the second surface of the repair fabric. Additionally, the cord protector may extend substantially farther away from the opening edge on one of the first and second surfaces than on the other of the first and second surfaces. Further, the cord protector may substantially cover one of the first and second surfaces.[0012]
• The prosthesis may be provided as a composite in which the cord protector is pre-attached to the repair fabric. Alternatively, the cord protector may be configured as an insert that is separate from and attachable to a prosthesis by a surgeon. This allows a surgeon to either retrofit a barrier-less inguinal hernia prosthesis or to employ an implantable repair fabric that may have various tissue or muscle wall defect repair applications.[0013]
• In a further embodiment of the invention, a cord protector is provided for use with a hernia prosthesis having a cord opening therethrough that is adapted to receive a cord-like structure. The cord protector includes a cord protecting insert that inhibits the formation of adhesions with sensitive tissue and organs. The cord protecting insert is constructed and arranged to be attached to at least a portion of the opening edge of the opening edge to isolate the cord-like structure from at least the opening edge of the hernia prosthesis.[0014]
• The cord protecting insert may include a backbone member. The cord protecting insert may include a flexible tube having a slot along a length thereof that is adapted to receive a portion of the hernia prosthesis along the cord opening.[0015]
• Other objects and features of the invention will become apparent from the following detailed description when taken in conjunction with the accompanying drawings. It is to be understood that the drawings are designed for the purpose of illustration only and are not intended as a definition of the limits of the invention.[0016]
BRIEF DESCRIPTION OF THE DRAWINGS
• The foregoing and other objects and advantages of the invention will be appreciated more fully from the following drawings, wherein like reference characters designate like features, in which:[0017]
• FIG. 1[0018]ais a perspective view of a prosthesis according to a first embodiment of the present invention;
• FIG. 1[0019]bis a cross-sectional view of a portion of the prosthesis taken along section line I-I in FIG. 1a;
• FIG. 2[0020]ais a perspective view of a prosthesis according to a second embodiment of the present invention;
• FIG. 2[0021]bis a cross-sectional view of a portion of the prosthesis taken along section line II-II in FIG. 2a;
• FIG. 3[0022]ais a perspective view of a prosthesis according to a third embodiment of the present invention;
• FIG. 3[0023]bis a cross-sectional view of a portion of the prosthesis taken along section line III-III in FIG. 3a;
• FIG. 4[0024]ais an exploded plan view of a barrier-less prosthesis and a separate cord protecting insert according to a fourth embodiment of the present invention;
• FIG. 4[0025]bis a cross-sectional view of the cord protecting insert taken along section line IV-IV in FIG. 4a;
• FIG. 5[0026]ais a perspective view of a cord protecting insert according to another embodiment of the present invention;
• FIG. 5[0027]bis a cross-sectional view of the cord protecting insert taken along a helical line V-V in FIG. 5a;
• FIG. 6[0028]aillustrates another embodiment of a prosthesis utilizing the cord protecting insert of FIGS. 5aand5b;
• FIG. 6[0029]billustrates a further embodiment of a prosthesis utilizing the cord protecting insert of FIGS. 5aand5b;
• FIG. 7[0030]ais a plan view of a cord protecting insert according to another embodiment of the present invention; and
• FIG. 7[0031]bis a cross-sectional view of a portion of the cord protecting insert taken along section line VII-VII in FIG. 7a.
DESCRIPTION OF ILLUSTRATIVE EMBODIMENTS
• FIGS. 1[0032]a-1billustrate one embodiment of aprosthesis10 which is particularly suited for inguinal hernia repair. Theprosthesis10 includes a layer ofrepair fabric12 formed of a material which is susceptible to the formation of adhesions with sensitive tissue and organs. Opposed from the layer ofrepair fabric12 is abarrier layer14 generally formed of a material which inhibits the formation of adhesions with sensitive tissue and organs.
• The[0033]prosthesis10 is configured with a cord opening orkeyhole18 therethrough for receipt of the spermatic cord for inguinal hernia repair. Thebarrier layer14 extends through and surrounds thecord opening18 and covers the opening edge to isolate the spermatic cord from the opening edge of the fabric. Thebarrier layer14 may be configured to overlap one or both surfaces of the layer ofrepair fabric12 in the area around thecord opening18. As illustrated, thebarrier layer14 covers one surface of the layer ofrepair fabric12 and overlaps a portion of the other surface of the fabric in close proximity to thecord opening18. The overlapping of thelayer12 around thecord opening18 by thebarrier layer14 may enhance the isolation of the spermatic cord from the layer of repair fabric as it passes through the prosthesis. This construction provides a composite prosthesis in which the surgeon does not have to fold the prosthesis at the edges during an inguinal hernia operation in order to place thebarrier layer14 in the desired position.
• The layer of[0034]repair fabric12 and/or thebarrier layer14 may configured to suit a particular repair procedure and/or provide particular adhesion/adhesion resistance characteristics. For example, the barrier layer may be configured to cover selected portions of the fabric so as to enhance tissue adhesion to particular portions of the prosthesis while limiting the incidence of tissue adhesion at other portions of the prosthesis to the spermatic cord and/or other sensitive tissue and organs in the repair region.
• FIGS. 2[0035]a-2billustrate another embodiment of aprosthesis20 for inguinal hernia repairs. Theprosthesis20 includes a layer ofrepair fabric12, abarrier layer14 and acord opening18 for the spermatic cord. In contrast to theprosthesis10 illustrated in FIGS. 1a-1b,thebarrier layer14 is configured to overlie selected portions of thefabric12. As best shown in FIG. 2b,thebarrier layer14 surrounds theopening18 and extends farther away from theopening18 along a portion of one surface of thefabric12 along which the spermatic cord may contact the prosthesis. Thebarrier layer14 acts as a cord protector that may be provided in those areas of theprosthesis20 expected to contact the spermatic cord.
• FIGS. 3[0036]a-3billustrate a further embodiment of aprosthesis30 for inguinal hernia repairs. Theprosthesis30 includes a layer ofmesh fabric12, abarrier layer14 and a cord opening for receipt of the spermatic cord. As illustrated, thebarrier layer14, or the cord protector, is limited to overlying portions of the fabric in close proximity to theopening18. This configuration would be expected to increase tissue adhesion to the prosthesis while limiting cord adhesion in the vicinity of the opening.
• In one embodiment, the layer of[0037]repair fabric12 is formed of a polyolefin material, such as a sheet of knitted polypropylene monofilament mesh fabric. One example of a suitable material is BARD MESH available from C.R. Bard, Inc. When implanted, the polypropylene mesh promotes rapid tissue ingrowth into and around the mesh structure.
• Other surgical materials which are suitable for tissue reinforcement and defect closure may be utilized including PROLENE, SOFT TISSUE PATCH (microporous ePTFE), SURGIPRO, TRELEX, ATRIUM and MERSELENE. Polyethylene may also form an acceptable polyolefin material for the[0038]layer12. Absorbable materials, including polyglactin (VICRYL) and polyglycolic acid (DEXON), also may be suitable. It also is contemplated that the mesh fabric may be formed from multifilament yarns and that woven, molded and other suitable methods of forming prosthetic mesh materials may be employed. It is to be appreciated that any suitable materials promoting fibroplasia may be used as would be apparent to one of skill in the art.
• In one embodiment, the[0039]barrier layer14 is formed from a fluoropolymer material such as polytetrafluoroethylene (PTFE). One example of a suitable material is a sheet of expanded polytetrafluoroethylene (ePTFE), such as GORETEX available from W.L. Gore & Associates, Inc., having a pore size (submicronal) that discourages tissue ingrowth and adhesion. Fluorinated ethylene propylene (FEP), tetrafluoroethylene (TFE) and ethylene tetrafluoroethylene (ETFE) are other acceptable fluoropolymers.
• A representative and non-limiting sampling of other suitable barrier materials includes silicone elastomer, such as SILASTIC Rx Medical Grade Sheeting (Platinum Cured) distributed by Dow Corning Corporation, TEFLON mesh, and microporous polypropylene sheeting (CELGARD). It is also contemplated that a polyethylene terephthalate, such as DACRON and MYLAR, may be employed as a barrier material. Autogenous, heterogenous and xenogeneic tissue also are contemplated including, for example, pericardium and small intestine submucosa. Absorbable materials, such as oxidized, regenerated cellulose (Intercede (TC7)) may be employed for some applications. It is to be appreciated that any suitable adhesion resistant materials may be used as would be apparent to one of skill in the art.[0040]
• In some instances, a surgeon may find it desirable to employ a cord protector that can be readily attached to a hernia repair prosthesis that is initially provided with no adhesion resistant barrier. FIGS. 4[0041]a-4billustrate one embodiment of a prosthesis utilizing a separablecord protecting insert40 which is attachable to a barrier-lessinguinal hernia patch42 formed with a layer ofrepair fabric12 that is susceptible to the formation of adhesions with sensitive tissue and organs. Thepatch42 includes acord opening18 for receipt of the spermatic cord. Thecord protecting insert40 is adapted to overlap and surround theopening18 in a manner similar to theprosthesis30 discussed above.
• In one embodiment, the separable or attachable[0042]cord protecting insert40 includes anouter barrier layer14 and a support member orbackbone44 which can be used to maintain the shape of thecord protecting insert40. Thebackbone44 can also be utilized to provide thecord protecting insert40 with sufficient rigidity that allows it to frictionally engage thepatch42. It is to be appreciated that any suitable arrangement as would be apparent to one of skill may be employed to attach the cord protecting insert to the fabric. For example, biological adhesives may also be utilized to bond thecord protecting insert40 to thebarrier-less prosthesis42. Thecord protecting insert40 allows existinghernia patches42 to be easily modified to provide spermatic cord protection.
• The cord protecting insert may be constructed in a manner that allows it to be readily attachable to repair fabric. In one embodiment illustrated in FIGS. 5[0043]aand5b,thecord protecting insert50 includes a long flexible tube having a slot along the length of the tube for receipt of a portion of the fabric along a keyhole or opening of a hernia patch. Thecord protecting insert50 may include abackbone54 in the form of a spiral thread or wire extending along the inside of thecord protecting insert50. Of course, the spiral threads forming thebackbone54 are discontinuous due to the slot in the tube. It is to be appreciated that the cord protecting insert may employ any suitable configuration.
• The flexible[0044]cord protecting insert50 may be particularly suited to retrofitting hernia repair patches having a cord opening of various configurations. FIG. 6aillustrates thecord protecting insert50 attached along the opening edge of ahernia patch62 provided with acord opening18 having a keyhole shape. FIG. 6billustrates thecord protecting insert50 attached along the opening edge of ahernia patch62′ with acord opening18 having anadditional flap64 provided for receipt of the spermatic cord. The cord protecting attributes of thecord protecting insert50 make the receipt of the spermatic cord onto the flap64 a viable possibility.
• As would be readily apparent to one of skill, the cord protecting insert may employ any configuration suitable for providing desired cord protection characteristics. FIGS. 7[0045]a-7billustrate another embodiment of acord protecting insert70 that may be attached to a barrier-less hernia patch. Thecord protecting insert70 is similar in shape to thebarrier layer14 ofhernia patch20 illustrated in FIGS. 2a-2bdiscussed above. Thecord protecting insert70 is adapted to fit around acord opening18 of a hernia patch and includes abarrier layer14 and abackbone74 which is adapted to give the appropriate rigidity to thecord protecting insert70 and provide for easy attachment to a barrier-less hernia patch. Thecord protecting insert70 includes an extension that is configured to overlie one side of the patch in a position likely to engage the spermatic cord.
• It is to be appreciated that the separable cord protecting inserts of FIGS.[0046]4-7 provide protective characteristics similar to those of the barrier layers14 employed with the composite prostheses illustrated in FIGS.1-3. In this regard, the barrier layers14 of FIGS.1-3 may be considered as cord protecting inserts that are integral with the prosthesis formed by the layer ofrepair fabric12. The separate cord protecting inserts of FIGS.4-7 allow for retrofitting existing barrier-less hernia prosthetics.
• It will be apparent that other embodiments and various modifications may be made to the present invention without departing from the scope thereof. For example, the cord protecting inserts may be formed of a material not requiring a separate backbone or supporting member. Further, inguinal hernia patches having alternative shapes may also be contemplated within the scope of the present invention. The foregoing description of the invention is intended merely to be illustrative and not restrictive thereof. The scope of the present invention is defined by the appended claims and equivalents thereto.[0047]

Claims (18)

What is claimed is:

1. A hernia repair prosthesis comprising:

a layer of repair fabric susceptible to the formation of adhesions with tissue and organs, the layer of repair fabric including first and second surfaces and an edge that extends between the first and second surfaces of the layer of repair fabric; and

a barrier that inhibits the formation of adhesions with tissue and organs, the barrier overlapping portions of the first and second surfaces and extending therebetween and along at least a portion of the edge to isolate the portion of the edge from adjacent tissue and organs.

2. The hernia prosthesis according toclaim 1, wherein the layer of repair fabric includes a plurality of interstices that allow tissue ingrowth.

3. The hernia prosthesis according toclaim 2, wherein the layer of repair fabric is formed from polypropylene.

4. The hernia prosthesis according toclaim 2, wherein the layer of repair fabric is formed from PTFE.

5. The hernia prosthesis according toclaim 1, wherein the barrier is formed from expanded PTFE.

6. The hernia prosthesis according toclaim 1, wherein the barrier extends substantially farther away from the portion of the edge on one of the first and second surfaces than on the other of the first and second surfaces.

7. The hernia prosthesis according toclaim 6, wherein the barrier substantially covers at least one of the first and second surfaces.

8. The hernia prosthesis according toclaim 1, wherein the layer of repair fabric includes an opening therethrough that is adapted to receive a cord-like structure, the edge including an opening edge that defines the opening, the barrier extending about the opening edge.

9. A hernia prosthesis for repairing a tissue or muscle wall defect, the prosthesis comprising;

a layer of repair fabric susceptible to the formation of adhesions with tissue and organs including first and second surfaces and an edge that extends from the first surface to the second surface; and

a barrier that inhibits the formation of adhesions with tissue and organs, the barrier being formed separate from and attached to the layer of repair fabric to permanently cover a portion of the edge to isolate the portion of the edge from adjacent tissue and organs.

10. The hernia prosthesis according toclaim 9, wherein the layer of repair fabric includes a plurality of interstices that allow tissue ingrowth.

11. The hernia prosthesis according toclaim 10, wherein the layer of repair fabric is formed from PTFE.

12. The hernia prosthesis according toclaim 10, wherein the layer of repair fabric is formed from polypropylene.

13. The hernia prosthesis according toclaim 9, wherein the barrier is formed from expanded PTFE.

14. The hernia prosthesis according toclaim 9, wherein the barrier overlies a portion of at least one of the first and second surfaces of the layer of repair fabric.

15. The hernia prosthesis according toclaim 14, wherein the barrier overlies a portion of each of the first and second surfaces of the layer of repair fabric.

16. The hernia prosthesis according toclaim 15, wherein the barrier extends substantially farther away from the edge on one of the first and second surfaces than the other of the first and second surfaces.

17. The hernia prosthesis according toclaim 16, wherein the barrier substantially covers at least one of the first and second surfaces.

18. The hernia prosthesis according toclaim 7, wherein the layer of repair fabric includes an opening therethrough that is adapted to receive a cord-like structure, the edge including an opening edge that defines the opening, the barrier extending about the opening edge.

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